title: Surgical site infections and bloodstream infections in infants after cardiac surgery.
abstract: OBJECTIVE
  Few recent studies have assessed the epidemiology of and risk factors for surgical site infections (SSIs) and bloodstream infections (BSIs) in infants after cardiac surgery. We hypothesized that infants younger than 30 days old and those with higher Risk Adjustment in Congenital Heart Surgery-1 scores would have an increased risk of SSIs, but not an increased risk of BSIs after surgery.
  
  
  METHODS
  We performed a retrospective cohort study of infants younger than 1 year of age undergoing cardiac surgery from January 2010 to December 2011 to determine the rates of SSIs and BSIs occurring within 3 months of surgery, risk factors associated with these infections, and causative pathogens. Multivariable associations using Cox proportional hazard modeling assessed potential risk factors for BSIs or SSIs.
  
  
  RESULTS
  Overall, 8.7% (48 of 552) of surgical procedures were complicated by SSIs (n = 19) or BSIs (n = 29). Thus, SSIs and BSIs occurred after 3.4% and 5.3% of procedures, respectively. Multivariate models found age younger than 30 days, incorrect timing of preoperative antibiotics, and excessive bleeding within 24 hours of surgery to be significant predictors for SSIs, and duration of use of arterial lines to be a significant predictor for BSIs. Gram-positive bacteria caused 75% of SSIs and BSIs and methicillin-susceptible Staphylococcus aureus caused 63% of SSIs.
  
  
  CONCLUSIONS
  We identified some potential strategies to reduce risk, including closer monitoring of timing of preoperative antimicrobial prophylaxis and enhanced efforts to achieve intraoperative hemostasis and earlier removal of arterial lines.
  
  
  CONCLUSIONS
  SSIs and BSIs remain important complications after cardiac surgery in infants.
authors.affiliation: Department of Pediatrics, Columbia University Medical Center, New York, NY.
authors.forename: Meghan T
authors.initials: MT
authors.lastname: Murray
authors.affiliation: Department of Pediatrics, Columbia University Medical Center, New York, NY.
authors.forename: Ganga
authors.initials: G
authors.lastname: Krishnamurthy
authors.affiliation: Department of Surgery, Columbia University Medical Center, New York, NY; School of Nursing, Columbia University Medical Center, New York, NY.
authors.forename: Rozelle
authors.initials: R
authors.lastname: Corda
authors.affiliation: Department of Pediatrics, Columbia University Medical Center, New York, NY.
authors.forename: Rebecca F
authors.initials: RF
authors.lastname: Turcotte
authors.affiliation: School of Nursing, Columbia University Medical Center, New York, NY.
authors.forename: Haomiao
authors.initials: H
authors.lastname: Jia
authors.affiliation: Department of Surgery, Columbia University Medical Center, New York, NY.
authors.forename: Emile
authors.initials: E
authors.lastname: Bacha
authors.affiliation: Department of Pediatrics, Columbia University Medical Center, New York, NY; Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, NY. Electronic address: LS5@columbia.edu.
authors.forename: Lisa
authors.initials: L
authors.lastname: Saiman
mesh_terms: D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002406:Catheterization, Peripheral / Q000009:adverse effects; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D015999:Multivariate Analysis; D009519:New York City / Q000453:epidemiology; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000517:prevention & control; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents